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Introduction to the Guideline, and General Principles of Acute Migraine Management

Published online by Cambridge University Press:  01 July 2015

Irene Worthington ,
Tamara Pringsheim ,
Marek J. Gawel ,
Jonathan Gladstone ,
Paul Cooper ,
Esma Dilli ,
Michel Aube ,
Elizabeth Leroux ,
Werner J. Becker  and
on behalf of the Canadian Headache Society Acute Migraine Treatment Guideline Development Group
Irene Worthington
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario
Tamara Pringsheim
Affiliation:
University of Calgary and the Hotchkiss Brain Institute, Calgary, Alberta
Marek J. Gawel
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario Rouge Valley Health System - Centenary, Toronto, Ontario Women's College Hospital, Toronto, Ontario, Canada
Jonathan Gladstone
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario Gladstone Headache Clinic, Toronto, Ontario
Paul Cooper
Affiliation:
University of Western Ontario, London, Ontario
Esma Dilli
Affiliation:
University of British Columbia, Vancouver, British Columbia
Michel Aube
Affiliation:
McGill University, Montreal, Quebec
Elizabeth Leroux
Affiliation:
University of Montreal, Montreal, Quebec
Werner J. Becker*
Affiliation:
University of Calgary and the Hotchkiss Brain Institute, Calgary, Alberta
*
Division of Neurology, 12th Floor, Foothills Hospital, 1403 29th St NW, Calgary, Alberta, T2N 2T9, Canada
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Abstract:

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Objectives:

To provide an overview of the objectives and target population of the guideline, and to review the general principles of acute pharmacological migraine therapy.

Methods:

A general literature review and several consensus groups were used to formulate an expert consensus for the general use of acute migraine medications.

Results:

The objective of the guideline is to assist the physician in choosing an appropriate acute migraine medication for an individual with migraine, and thereby to reduce migraine-related disability. The target population includes adults with episodic migraine (patients with migraine headache < 15 days/month). This guideline is intended primarily for physicians who treat patients with migraine. Other health professionals may also find this guideline helpful. Acute migraine therapy should be considered for the great majority of patients with migraine. A specific acute medication is chosen based on evidence for efficacy, tolerability, migraine attack severity, patient preference, and on the presence of co-existing disorders. General principles of acute migraine therapy include that the response of a patient to any given medication cannot be predicted with certainty, and that treatment early in the attack is generally more effective than treatment later once the migraine attack is fully developed. A suitable treatment approach (stratified or stepped approaches) and drug formulation (injection, tablet, wafer, powdered formulation, or nasal spray) should be chosen based on patient clinical features. Excessively frequent use of acute medications (medication overuse) should be avoided. Two or more acute medications can be combined if necessary.

Conclusions:

This guideline provides evidence-based advice on the use of acute medications for migraine, and should provide useful guidance for acute migraine therapy to both health professionals and patients.

Type
SECTION I
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue S3 , September 2013 , pp. S4 - S9
Copyright
Copyright © The Canadian Journal of Neurological 2014

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